Claims information for employers
An employer has many roles in the claims process when an employee submits a claim for a work-related injury or illness.
Role of employers in the claims process
An employer has responsibilities to ensure that a workplace is safe for their employees, and to support the claims and rehabilitation process when an employee is injured while at work.
The claims and rehabilitation process is managed through the Safety, Rehabilitation and Compensation Act 1988 (SRC Act).
Employers covered by the SRC Act fall into two categories:
- Australian Government agencies or statutory authorities, including those with delegated claims arrangements
- Self-insured licensees.
Some employer responsibilities in the claims process may be carried out by employees within the organisation. These include roles such as claims managers, rehabilitation case managers, senior managers and middle managers and supervisors.
When an employee submits a claim for a work-related injury or illness, the claims manager will gather and review information from the employee, their employer and treating medical practitioners to determine liability.
During this information gathering stage, an employer can submit a statement to the claims manager. The employer statement should be in writing and include relevant factual and objective information and documentation in relation to the employee’s claim.
The claims manager reviews the information that has been provided, including medical evidence, and assesses whether the application complies with legislative requirements and if additional information is required. They will then determine if liability is accepted.
For more information, see:
- Workers’ compensation claims for the process of submitting a claim.
- How a claim is assessed for the tests and criteria applied by the claims manager.
If a claim for workers’ compensation is accepted, each claim for income support, medical treatment or other entitlement must be assessed on its own merit before it can be accepted and paid.
Acting early and supporting an employee with early intervention is critical to their recovery and can minimize the impact and duration of symptoms related to the injury or illness.
For more information about how to put early intervention into practice visit the Intervene early and know the warning signs webpage.
Before a claim is accepted
Medical treatment costs before liability is determined
An early intervention program that pays for medical treatment costs for an injured or ill employee, may assist with returning the employee to health and work sooner, rather than waiting for a determination on liability.
Australian Government agency or statutory authority
If liability is accepted, you will be able to claim reimbursement for treatment costs incurred by the employee in relation to their claim from the accepted date of injury. If liability for the employee’s injury is denied, the cost of treatment will not be reimbursed.
Treatment should be ‘reasonable’ and at a cost that is deemed ‘appropriate,’ in accordance with the clinical framework for the delivery of health services. Treatment should be recommended in writing by the employee’s treating health practitioner and appropriate for the compensable condition claimed. Physiotherapy or Psychology treatment is considered ‘reasonable’ to a limit of five consecutive sessions before a treatment notification plan from the treating practitioner is required. A claims manager will review and determine if the treatment will be reimbursed.
If the cost of treatment received exceeds scheduled limits, you will be liable for the gap amount. A full list of the fee schedule can be found on our website at the rates for medical and allied health treatment webpage.
If you are a self-insured licensee, staff within your organisation or a third-party provider manage employee claims. Your Human Resources area can provide more information regarding your organisation’s early intervention policy and procedures.
Rehabilitation before claim liability is determined
A rehabilitation assessment and program can be provided to an employee under your organisation’s early intervention or rehabilitation policy and procedures or under the Safety, Rehabilitation and Compensation Act 1988 (SRC Act).
Australian Government agency or statutory authority
Comcare will pay for the costs associated with an employee’s rehabilitation, under section 36 and 37 of the SRC Act, if a workers’ compensation claim has been submitted and you are waiting on a liability determination.
If liability for the claim is denied, a rehabilitation assessment and program can no longer be provided under the SRC Act, however, rehabilitation costs will be reimbursed up to the date of determination.
For more information visit the Rehabilitation information for employers webpage.
In cases where the employee has transferred to or is on secondment to another agency at the time of injury, the claims manager will need to establish the liable agency.Factors such as the transfer or secondment agreement and conditions, and who is paying the employee’s salary at the time of the transfer or secondment, are all relevant when determining who is the liable agency.
For information on the liable employer, visit the Rehabilitation information for employers webpage.
When a claim is not accepted
If liability for a claim is not accepted, it is still important for employers to support the employee to safely remain at, or return to, work.
You should consider assigning a rehabilitation case manager or appropriate staff member to support the employee to transition back to the workplace.
See providing suitable employment for other options you may put in place to help an employee return to work.
After a claim is accepted
Ensuring necessary supports are in place
Once a claim is accepted, the employer plays a key role in ensuring the necessary supports are in place.
The claims manager will work as part of a team with the employee, their employer, the rehabilitation case manager and treating practitioners to support the employee to return to health and safely remain at, or return to, work.
The employer plays a key role by assigning a rehabilitation case manager to support the injured employee and ensuring that supervisors and senior managers have the appropriate training to carry out their duties in assisting the injured employee to return to health and work.
It is recommended that employers develop and maintain a rehabilitation management system to help meet obligations under the legislation and provide better rehabilitation services to employees. Visit Rehabilitation management system and auditing for more information.
For more information see:
- Rehabilitation information for employers for further details on your rehabilitation responsibilities.
- Return to work process for employers for information on returning employees to the workplace
- Providing suitable employment for other options you may put in place to help an employee return to work.
Employers hold a range of information relating to employees, including personal and medical information not related to the compensable injury. This should be held separately to the compensation file. Employers need to be aware of obligations under the Privacy Act 1988 and manage this information in line with the purpose in which it was obtained.
Support for employers through the claims process
Australian Government agencies and statutory authorities have access to various levels of support to assist in supporting employees with a claim in the workplace.
- Account managers who can support employers with specific information in relation to their organisation and workers’ compensation claim performance
- Rehabilitation and allied health specialists to provide advice during the rehabilitation process.
Comcare’s Customer Information System (CIS) provides employers with information about their agency’s injury management and claims performance. Agencies will need to nominate a CIS administrator who is responsible for authorising all agency access requests and the level of access required by each user.
Information on the available services is located on our website. See:
Courses for employers on the claims process
We provide training for employers through our learning management system called Comcare LMS.
To access our training, you first need to create an account in Comcare LMS (see the steps to create an account). Then, select the training course you are interested in and login with your email and password.
For more information about the courses we offer, see Training and learning.